RUcore Resource Object
RUcore Resource Object
TitleThe impact of cardiopulmonary bypass surgery on cancer prognosis
NamePinto, Cathy Anne (author), Marcella, Stephen (chair), DEMISSIE, KITAW (internal member), Holland, Bart (internal member), August, David (outside member), Rutgers University, Graduate School - New Brunswick,
Degree Date2011-10
Date Created2011
SubjectPublic Health,
Cardiopulmonary bypass ,
Cancer—Mortality
DescriptionThe aim of this research was to evaluate the impact of cardiopulmonary bypass (CPB) on cancer progression in a large population-based cardiovascular cohort using linked data from several state-wide registries. The underlying clinical hypothesis is that CPB causes a transient immunosuppression, beyond that caused by surgical intervention, which triggers the progression of dormant malignancies and accelerates metastatic disease. The primary endpoints were cancer incidence, stage, and cancer-specific mortality. The largest study was a retrospective cohort study of coronary artery bypass graft surgery, with and without CPB, in 43,347 patients with no prior cancer diagnosis. For overall cancer incidence, there was a 17% increase in patients with pump versus off-pump surgery (1.17 (95% CI , 0.93-1.47: p=0.19)); however, this result did not reach statistical significance, nor was there a significant association found with cancer stage. Of 11 site-specific analyses, a statistically significant increase in the risk of skin melanoma (1.66 (95% CI, 1.08-2.55: p=0.02)) and lung cancer (1.36 (95% CI, 1.02-1.81: p=0.03)) was observed for patients with pump versus off-pump surgery. However, besides skin melanoma, no consistent effect was observed for other cancers thought to be susceptible to immune modulation (e.g. NHL, renal cancer). With respect to cancer-specific mortality, there was a 16% increase for patients with pump versus off-pump surgery (1.16 (95% CI, 0.92-1.46: p=0.20)). Of those patients diagnosed with a malignancy after surgery, there was a 12% increase in risk for patients with pump procedures (1.12 (95% CI, 0.89-1.41: p=0.33)). Although an increase in mortality risk, neither result reached statistical significance. Two smaller studies were also conducted in patients with a history of cancer; however, these studies were less generalizable and more susceptible to selection bias. In summary, the overall results do not demonstrate any strong or clinically meaningful association between CPB and cancer progression. If the increased risk demonstrated in Study 1 is real, the effect is likely modest at best and not likely to influence clinical management of patients with bypass surgery Even so, further research may still be warranted, with particular focus on skin melanoma and lung cancer which had the largest associations in these studies.
NotePh. D.
NoteIncludes bibliographical references
NoteIncludes vita
Noteby Cathy Anne Pinto
Genretheses
Persistent URLhttp://hdl.rutgers.edu/1782.1/rucore10001600001.ETD.000063570
Languageeng
CollectionGraduate School - New Brunswick Electronic Theses and Dissertations
Organization NameRutgers, The State University of New Jersey
RightsThe author owns the copyright to this work.